Primary care and the treatment of opioid use disorder (OUD) continue to be fragmented despite the development of several models addressing their integration. This scoping review identified current models of integrated care, and identified facilitators of and barriers to successful implementation. Starting with a literature review, the authors identified core components of each model and conducted interviews with key informants. Twelve models of care were identified:
- All models utilized medication for treatment of OUD, with most using buprenorphine/naloxone.
- Most, but not all, models performed outreach to prescribers (e.g., buprenorphine waiver trainings). Some provided additional support for nurses.
- A few models leveraged outreach to improve program acceptability within the community, incorporating primary-care based OUD treatment with other medical care (i.e., HIV and HCV treatment and prenatal/postpartum care).
- Most models had a clinical coordinator to manage aspects of OUD care. Some linked systems of care through coordinated efforts between locations, including bridging patients from one level of care to primary care (e.g., emergency department or inpatient to primary care-based buprenorphine/naloxone providers).
- All models provided linkage to additional behavioral health services; however, many were to off-site providers.
Comments: Models of OUD treatment integrated into primary care share the use of evidenced-based medication, linkage to additional medical/behavioral health care services, and facilitating training to support providers. There are at least 12 models available that programs can adapt and customize to their specific setting, but there has yet to be a trial that compares effectiveness of treatment outcomes between care models.
Brittany L. Carney, MS† and Alexander Y. Walley, MD, MSc
†Contributing editorial intern and DNP candidate, University of Massachusetts Medical School, Graduate School of Nursing
Reference: Korthuis PT, McCarty D, Weimer M, et al. Primary care-based models for the treatment of opioid use disorder: a scoping review. Ann Intern Med. 2017;166(4):268–278.